Hospital-acquired infections are contracted because of infections existing in various locations, mostly the hospitals. Hospital-acquired infections are not present after a patient has been placed under medical care. One of the most prevalent locations within the hospital that healthcare-acquired infections occur is the intensive care unit. Nosocomial infections are linked with high hospital costs, morbidity and mortality. The cases of nosocomial infections are expected to continue rising as the complexity of medical care continues to grow, including resistance to antibiotics. However, hospital-acquired infections can be thwarted through observing proper hygiene.
The primary nosocomial infections causative agents include viruses, fungus and bacteria. However, bacteria cause more than 90% of hospital-acquired infections. The compromised immune system of people admitted in hospitals makes it easier for them to acquire the infections. The most prevalent bacteria accountable for causing nosocomial infections include Staphylococcus aureus , Escherichia coli and Pseudomonas aeruginosa .
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Health-acquired infections appear after 48 hours following hospitalization or 30 days after having received healthcare. According to the CDC, more than 2 million hospitalized patients are affected by nonsocial nosocomial in the USA, while another 90,000 die because of the infections (Stone, 2009). Nosocomial infections have been cited as being one of the top ten primary causes of death in America. 7 out of 100 and 10 out of 1000 hospitalized patients in first world countries and emerging nations respectively acquire nosocomial infections. The nosocomial infections cost the USA taxpayers between $28 and $45 billion annually (Stone, 2009). However, the shocking factor is that nosocomial infections are preventable through observing proper hygiene, including handwashing and providing patients with a clean environment. These intervention measures are simple to implement and are not costly.
PICOT Question
Among patients diagnosed with nosocomial infections such as urinary tract infections, respiratory pneumonia and surgical site wound infections, does washing hands before and patient care by health care providers and providing a clean environment compared to wearing a mask or gloves and using a complete antibiotic dose help in reducing infections through eliminating bacteria and decreasing antibiotic use from patient admission to discharge?
The sources used in the literature review will be retrieved from various databases such as EBSCO Host, Google Scholar, PubMed Central and Biomed Central. The keywords used during the search process include “handwashing, antibiotic resistance, hospital-acquired infections, nosocomial infections, healthcare-associated infections, and hygiene”. Articles that are more than ten years old shall not be used in the literature review. Books, magazines and newspaper articles shall not be used in the literature review.
Credibility of Articles
The major strength of the five articles is that they are peer-reviewed. This indicates that they have undergone thorough editing and review before they can be published in the journal databases. Moreover, the journal articles are current with the oldest one being published in 2011. The articles also contain relevant information to the study topic. The researchers who carried out the studies are also experts in their field, ranging from a healthcare practitioner to other professionals within healthcare. The language used in the articles is not inflammatory, and this makes them have some form of objectivity. However, the articles sue specialized terminologies that can be difficult for non-specialists to fathom. The articles are also not available at times and require one to purchase from the associated databases.
Article Contrast and Comparison
According to a study by Peters et al. (2018), there have been very few works of literature that have demonstrated the impact of having a clean environment in preventing HAIs. The article found out that the hospital environment is important in eliminating the spreading of infections. Hands have been identified as being the chief vectors for spreading infections from one patient to the other. More than 50-70% of HAIs are spread through contaminated hands. Mathur (2011) gives historical background on handwashing. According to the author, in the early 19th century, the significance of handwashing was conceptualized in healthcare. The occurrence of maternal mortality and puerperal fever was reduced through handwashing. According to a study carried out by Labarraque (Mathur, 2011). In 1975 and 1985, the Centre for Disease Control and Prevention published guidelines that were to be adopted by healthcare centers on handwashing.
In 2006 and 2009, the World Health Organization also outlined the importance of handwashing through publishing the “Hand Hygiene in Health Care” rules and the “SAVE LIVES: Clean Your Hands” respectively (Mathur, 2011). According to Mathur (2011) and Peters et al. (2018), they believe that handwashing is vital towards infection control in health care. Peters et al. (2018) found out that there is a need to establish evidence-based procedures for maintaining a clean hospital environment if HAIs are to be prevented. The nursing assistants should be at the forefront of ensuring there a clean hospital environment. Manual cleaning and disinfecting.is one of the most effective means through which a hospital environment can be kept clean. However, Mathur (2011) stresses more on handwashing as the only means of HAIs control, while Peters et al. (2018) maintains that it is vital to have a general clean hospital environment.
Simoes et al. (2016) state that nosocomial infections causes more than 37,000 deaths in Europe and another 75, 000 deaths in the USA annually. The health care costs associated with HAIs amounts to $9.8 billion annually. The major problem leading to nosocomial infection is antibiotic resistance. According to the CDC, more than 23,000 people die because of antibiotic resistance, while another 2 million acquire antibiotic resistance annually in the USA (Simoes et al., 2016). The only means of averting HAIs is through education Antibiotic Stewardship Programs, environmental cleaning, staff education and reinforcing handwashing have been implemented as the main measure for controlling HAIs (Simoes et al., 2016; Mathur, 2011; Peters et al., 2018). However, according to Simoes, et al. (2016), the earlier detection of infections is key towards prevention and controlling HAIs, and this requires all hospitals to have a microbiology laboratory.
Mehta et al. (2014) state that prevention of infections is vital towards controlling infections similar to the findings from a study by Simoes et al. (2016). Mehta et al. (2014) state that there are various guidelines towards infection control in healthcare and they include isolation, observing hand hygiene and following standard precautions such as using sterile gloves wearing a gown and using patient care equipment. The authors also found out that other strategies towards infection control include following transmission-based precautions and considering environmental factors such as cleaning and disinfection, similar to a study by Peters et al. (2018). A similar study by McLaws (2015) found out that hand hygiene has been cited as being key towards eliminating and reducing HAIs. This is similar to the studies by Simoes et al. (2016) Peters et al. (2018), Mathur (2011) and Mehta et al. (2014). However, McLaws (2015) states that the linkage between HAIs control and hand hygiene is complicated. However, McLaws (2015) cites that various errors arise when implementing hand hygiene as a HAI control strategy, which impedes its ability to control nosocomial infections. The measurement error is used in determining the outcome of a variable. In this case, compliance using hand hygiene is the measurement error. McLaws states that there has been an increased non-compliance in health care. Moreover, McLaws (2015) states that hand hygiene is not the only measure towards preventing nosocomial infections, as the prevention requires multiple concurrent interventions.
Gaps in Literature
According to studies by Peters et al. (2018), Mehta et al. (2014), Simoes et al. (2016) and Mathur (2011), hand hygiene is the best strategy towards preventing HAIs in healthcare. Peters et al. (2018) and Mehta et al. (2014) have cited that maintaining a clean hospital environment among other strategies are key towards HAI control. However, the study by McLaws (2015) states that the relationship between hand hygiene and maintaining a clean environment and reduced HAI has not been strongly researched. There have been very many hygiene campaigns since the release of the 2007 and 20089 WHO guidelines. However, very little research has been conducted on the national or local success of hygiene in reducing HAI. The articles have only cited hand hygiene is key towards reducing HAIs, but there has been no evidence to fully show that is the case. Therefore, there is a need to provide evidence on how handwashing and maintaining a clean environment leads to HAIs reduction.
Conclusion
Following the increased mortality and morbid rates caused by HAIs, there is a need to have in place effective strategies to reduce the incidence of the nosocomial infection. The main reduction strategies include observing proper hygiene enabled by handwashing and maintaining a clean hospital environment. To ensure health care centers adopt this change in practice, there is a need to have in place a cross-functional team. According to Peters et al. (2018), nursing assistants have been cited as playing a key role in maintaining a clean hospital environment thus eliminating HAIs. However, it is vital to include other health professionals such as physicians, nurses, doctors, and specialist. It is also important to ensure that patients are part of the teams to make sure that hygiene is properly maintained in the healthcare facilities.
The proposed change in practice shall be implemented through campaign awareness and educational programs. Flyers containing the required guidelines shall be distributed across the healthcare facility. The health care staff shall also undergo 1-hour training and education every day on how to maintain a clean hospital environment and why it is important. The trainings shall last for three weeks. The flyers shall mostly be distributed to the patients. The evaluation of the proposed change success shall be determined through observing the HAIs infection rate before the program and three months after the program guidelines have been implemented. A decrease in HAIs will indicate the program is a success. The costs to be used in the planning will include remuneration offered to the committee in charge of implementing the program and drafting the guidelines, printing, purchasing hardcopy papers and payments made to the graphic designers. In the evaluation, the main costs will include payments made to the statistical consultant who shall analyze the data. Other costs will include paying guests speakers during the training and awareness period.
The main barriers that can hinder the implementation of the changes are resistance from hospital staff and non-compliance among the patient and hospital staff. The main means of managing resistance to change is through identifying the root cause of resistance. Most of the resistance indicators are noticeable and can include not attending meetings, training and even not providing requested resources and information. There is a need to show the employee that the new changes will not lead to any job losses and ensuring the management offers visible support and commitment. Non-compliance shall be managed through awarding hospital staff and patients who champion for hygiene as a key strategy towards eliminating HAIs.
There is a need for further research on why implementing hygiene guidelines to reduce HAIs is, at times, hard to implement. Despite the WHO and CDC laying down guidelines, HAIs have continued to increase including deaths resulting from the infections.
References
Mathur, P. (2011). Hand hygiene: back to the basics of infection control. The Indian Journal of Medical Research , 134 (5), 611.
McLaws, M. L. (2015). The relationship between hand hygiene and healthcare-associated infection: it’s complicated. Infection and Drug Resistance , 8 , 7.
Mehta, Y., Gupta, A., Todi, S., Myatra, S. N., Samaddar, D. P., Patil, V., & Ramasubban, S. (2014). Guidelines for the prevention of hospital-acquired infections. Indian Journal of Critical Care Medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine , 18 (3), 149.
Peters, A., Otter, J., Moldovan, A., Parneix, P., Voss, A., & Pittet, D. (2018). Keeping hospitals clean and safe without breaking the bank; summary of the Healthcare Cleaning Forum 2018. Antimicrobial Resistance & Infection Control, 132.
Simões, A. S., Couto, I., Toscano, C., Gonçalves, E., Póvoa, P., Viveiros, M., & Lapão, L. V. (2016). Prevention and control of antimicrobial-resistant healthcare-associated infections: the microbiology laboratory rocks! Frontiers in Microbiology , 7 , 855.
Stone, P. W. (2009). Economic burden of healthcare-associated infections: an American perspective. Expert review of Pharmacoeconomics & Outcomes Research , 9 (5), 417-422.
